For many parents, prying a teenager’s eyes from TikTok or Instagram is a nightly battle. For those whose children have attention deficit hyperactivity disorder (ADHD), it can feel like a never-ending war.

Adolescents with ADHD are particularly prone to long hours of compulsive scrolling, the result of differences in how their brains regulate attention and reward. They are also disproportionately likely to use social media in dangerous ways — sharing personal information, engaging in risky interactions and staying online deep into the night — to the detriment of schoolwork, sleep, friendships and general well-being.

Nature Outlook: ADHD

It is now well established that a strong link exists between ADHD and social-media use. What remains uncertain is the direction of the relationship: does extensive screen time worsen ADHD symptoms, or do the traits of ADHD make teenagers more prone to unhealthy patterns of time spent online?

The answer, clinicians say, is probably a bit of both, with a feedback loop driven by a mix of neurobiological vulnerabilities, reward-seeking behaviours and the ever-present lure of digital platforms engineered to keep users hooked. “It’s very hairy,” says Meredith Gansner, a child psychiatrist at the University of Rochester Medical Center in New York. “I do caution parents of children with ADHD to be extra mindful about their kids’ use of social media.”

So the question becomes: what can they do about it? Cutting off access to social media can backfire, straining family ties and leaving teenagers feeling isolated from their peers. Yet ignoring the problem risks deepening the very struggles that define ADHD — impulsivity, distractibility and difficulties maintaining healthy relationships offline.

Because researchers still can’t say definitively whether social media fuels ADHD or simply feeds on it, or which brain circuits intersect with digital stimulation to mould the developing mind, families are stuck navigating the grey area of what to do next.

Screening for ADHD

One of the first studies to tie social-media use to later ADHD symptoms was published in 2018 by Adam Leventhal, a clinical psychologist at the University of Southern California’s Keck School of Medicine in Los Angeles.

Previous work had connected earlier electronic media, such as television and video-games, to modest increases in attention problems. But those formats were slower and less interactive. Newer smartphone-era platforms deliver content with a pace and stimulation intensity that earlier generations of adolescents never encountered. And, as Leventhal and his colleagues discovered, the impact is far more pronounced.

The researchers followed more than 2,500 secondary-school students in the Los Angeles area, asking them to regularly describe how frequently they engaged in digital-media activities and whether they were experiencing symptoms consistent with ADHD. Over the two-year study period, those who frequently browsed social-media sites, streamed videos or interacted online in other ways were roughly twice as likely to develop ADHD symptoms as their peers who rarely logged on1.

Larger and longer confirmatory studies soon followed, including some designed to tease out the effects of different digital media platforms statistically. For instance, a five-year study of nearly 4,000 Canadian youths found that heavy use of social media increased impulsivity and other ADHD-related symptoms more than television and video-games did2. The habit also tended to snowball: the more time teenagers spent on digital platforms, the more their impulsive tendencies grew, feeding into worsening behavioural problems.

Patricia Conrod, a clinical psychologist at the University of Montreal in Canada, who led the study, thinks that the findings reflect impairments in the brain’s ability to hit the brakes on impulsive urges. “We have a kind of neurocognitive mechanism to explain this long-term relationship,” she says.

Wired for distraction

Brain scans can provide clues about what might be happening at a neuroanatomical level. A team led by Samson Nivins, a neuroscientist at the Karolinska Institute in Stockholm, analysed magnetic resonance imaging data from more than 6,400 children enrolled in the Adolescent Brain and Cognitive Development Study, a massive long-term cohort study of US teenagers. The researchers found that over a period of four years, heavy social-media use was linked to subtle changes in the cerebellum, a brain region involved in attention, reward processing and motor control. Compared with their peers, children who spent more time on YouTube, WhatsApp and other social-media platforms showed a slight decline in the growth trajectory of the cerebellum3 (see ‘The toll of the endless scroll’).

Further analyses published last month by Nivins’s team, using data from the same longitudinal cohort study, showed that more time on the apps both preceded and predicted rising attention difficulties4 — a pattern that other researchers have documented as well5. “Social media is increasing the inattention symptoms,” Nivins says. “It’s not the other way around.”

Even so, researchers stress that the picture is far from complete. Most of the existing work, including that by Nivins, has relied on data collected years ago — a period when TikTok was still in its infancy and before the latest wave of algorithm-driven platforms and AI-generated content. Given how rapidly technology evolves, it’s an open question whether today’s apps exert even stronger effects on developing brains, or perhaps different ones altogether, says Ashley Halkett, a social psychologist at Stanford University School of Medicine in California.

Restricted use

This disconnect speaks to one of the central difficulties in studying the consequences of fast-moving digital trends on adolescents’ mental health and brain development. “We’re always sort of one step behind,” says Karolinska neuropsychologist Lisa Thorell.

Policymakers are no longer waiting for the science to catch up. From Europe and Australia to parts of the United States and beyond, lawmakers have started advancing measures to restrict adolescents’ access to social-media platforms, citing mounting evidence of harms to young people’s well-being. Although not explicitly focused on ADHD, these measures reflect a growing consensus that the risks of unregulated access outweigh the benefits for minors.

Whether such restrictions will be enough for young people with ADHD remains an open question, however. Clinicians stress that the vulnerabilities of these adolescents — impulsivity, heightened reward sensitivity and difficulties with self-regulation — could make them especially ill-equipped to navigate online environments, even with tighter rules.

Adding to the challenge is the day-to-day reality for parents. Children with ADHD can be particularly hard to manage, being restless, distractable and quick to escalate, so handing back a phone or tablet is often the path of least resistance. Screens can be reliable babysitters, too, keeping kids occupied long enough for parents to get through work calls, cook dinner or simply take a breather.

But what buys peace in the short term can fuel bigger problems over time, as the very platforms that soothe the restlessness also reinforce the patterns of compulsive use that parents most want to avoid. “It’s going to be easier in your daily life if you use screens a lot,” Thorell says. “But in the long run, it’s going to create more problems.”

Innocence interrupted

That tension between short-term relief and long-term risk is one that families navigating ADHD encounter daily. In some cases, it can spiral into dangerous territory for vulnerable adolescents.

Consider the experience of Shelley, a teenager living in western Canada whose name has been changed to protect her privacy. At first, social media offered Shelley an outlet for creativity and a way to connect with fellow fans of therian masks, a niche subculture devoted to role-playing as animals. She was 11 years old then and had been diagnosed with ADHD three years earlier. Her mother’s YouTube account provided a venue for sharing her handmade masks and the videos she filmed in the forest. “It was a creative thing in my mind,” says Shelley’s mother. “It seemed really innocent.”

But the comments posted beneath those videos soon led to private chats on Discord, where the atmosphere was much darker. It was there that Shelley encountered peers who openly discussed self harm. She also started interacting with an older man, and her parents feared he was grooming Shelley for real-world encounters.

This kind of online spiral could happen to any pre-teenager, but in Shelley’s case her ADHD probably heightened the risks, says her mother. The impulsivity and restless search for stimulation that comes with the condition made it harder for Shelley to disengage once drawn in, and more difficult to recognize when interactions had turned unsafe.

“ADHD puts young people at risk,” says Conrod. “They are susceptible to cues, triggers and scenarios that lure them into reinforcement-based behaviours, and it takes a lot of cognitive control to resist some of these vices that exist in society” — a capacity that people with ADHD often struggle to summon.

“All the pieces of social media really hit that little ADHD brain,” says Shelley’s mother. Once she discovered what was happening, she reported the behaviour to the authorities and cut off Shelley’s access to YouTube, Discord and similar platforms.

Now 14, Shelley still gravitates towards online communities and regularly uses a smartphone to text her friends. But her parents make a point of monitoring Shelley’s digital life closely and steering her towards safer, more constructive outlets for her creativity. They have learnt that simply taking phones or Internet access away isn’t realistic for someone her age — social connection is too central to teenage life. Instead, they focus on helping Shelley have healthier patterns of use, setting boundaries around time and content while keeping communication open.

This approach reflects a broader shift in thinking about how to address the risks of social media, especially in the context of ADHD. “The idea of saying ‘less screens’ or ‘no screens’, while potentially beneficial, is a difficult intervention to implement,” says Leventhal. “Instead, focusing on the types of digital-media use patterns and content that may be most harmful — and intervening there — is likely where the future lies.”

For young people with ADHD, growing up at a time when social media saturates nearly every corner of life, that future can’t come soon enough.